Updated 23 September 2021
The Isle of Wight NHS Trust is the only integrated acute, community, mental health and ambulance health care provider in England. Established in April 2012, the trust provides a full range of health services to an island population of about 143,000 people.
Overall, the trust provides 23 core services for acute, community, mental health and ambulance services.
Acute services are based at St Mary’s Hospital Newport with 245 beds. Services include emergency department, urgent care service (by referral only), emergency medicine and surgery, planned surgery, intensive care, paediatric services, a special care baby unit (SCBU), and maternity care services. Along with diagnostic and screening, pathology and pharmaceutical and outpatient services.
The community division provides a variety of supported care services within patients' homes, community settings, GP practices and clinics, as well as providing physiotherapy, occupational therapy and podiatry support within the acute setting. The community clinical provision is based in three localities of the Isle of Wight: Northeast, West and Central, and South Wight, with district nursing provision in each area. There is also support offered for children and young people through the paediatric therapy, occupational therapy, physiotherapy and speech and language therapy services.
The mental health division provides community learning disability services; inpatient and community based mental health care. With 32 beds for working age and older adults, supported by a home treatment team and a community mental health team for adults and child and adolescent mental health services.
The ambulance service division includes operational delivery units for the 999 emergency ambulances, NHS111 and patient transport services based at the St Mary's Hospital site.
We carried out this announced inspection of a range of the mental health, acute and community services provided by this trust as part of our continual checks on the safety and quality of healthcare services. We did not inspect ambulance service division on this occasion. At our last inspection we rated the trust overall as requires improvement and remained in quality special measures. No use of resources review was carried-out for this inspection.
We inspected the following core services and rated them individually for the five key questions of safe, effective, caring responsive and well led. We also inspected the well-led key question for the trust overall. We rated 11 out of 11 services inspected as good.
At this inspection, overall, we rated safe, effective, caring, responsive, and well-led as 'good'. Our separate rating of well-led for the trust was good.
Diagnostic Imaging: all five key questions were rated good. Good overall
Medical Services: all five key questions were rated good. Good overall
Surgical Services: safe, effective responsive and well led were rated good, with caring rated as outstanding. Good overall
Gynaecology Services: safe, effective, caring and responsive were rated good and well led rated was rated requires improvement. Good overall
Children and Young People: all five key questions were rated good. Good overall
Acute wards for adults of working age and psychiatric intensive care units: Effective, caring, responsive and well led rated good with safe rated as requires improvement. Good overall
Wards for older people with mental health problems: all five key questions rated good. Good overall
Community based mental health services of adults of working age: safe, effective, caring and well led rated good with responsive rated as requires improvement. Good overall
Mental health crisis services and health-based places of safety: effective, caring, response and well led rated as good with safe rated as requires improvement. Good overall
Community adults: safe, effective, responsive and well led rated as good with caring rated as outstanding. Good overall
Community inpatients services: safe, effective, responsive and well led rated as good with caring rated as outstanding. Good overall
On this occasion, we did not inspect the ambulance service division. In rating the trust, we took into account the current ratings of the 11 core services we did not inspect this time but had rated previously.
Our rating of well led improved. We rated them as good because:
The trust leadership demonstrated the delivery of improvement plans over time and had plans for a strategy refresh to progress the quality of care delivery for the future.
There was a clear vision for now and the future of healthcare on the island.
Across the trust teams were determined to meet the needs of patients and the public.
The executive team showed the drive to make the trust a better place for staff to work in.
Staff were mostly satisfied with working at the trust which was the island’s main employer.
Staff were able to directly influence the quality of services and make changes in their own areas.
There were quality improvement objectives and audits to identify progress and next steps.
Recruitment internally and externally, including from overseas, had benefited the trust services.
Engagement with staff, patients, partners and the system were much improved and were effective.
New approaches for communication were introduced and there was renewed vigour to continually improve the communication for patients and their relatives.
There were established systems and partnership working for the sustainability of the organisation which was for the benefit of the population of the Isle of Wight.
The partnership links were contributing to the success of supporting patients to have good care and treatment on the island.
The culture, enthusiasm and energy for the quality of patient care showed significant improvement.
There was a greater patient focus than seen before.
There was established support for staff care and wellbeing as confirmed by the improved staff survey outcomes and as seen throughout all areas inspected.
The strategy for equality and inclusion was far more developed and was working towards meeting the needs of people with protected characteristics.
There was a developing research team and projects underway.
Delays in mandatory training delivery, such as for safeguarding and resuscitation, could impact on patient care.
The trust had identified information technology systems needed new investment, the continued delays affected the cohesiveness and modernisation of the trust’s information management.
The trust’s non-executive directors lacked visibility in some services which had previously been identified before the pandemic restrictions.
Recruitment to some key roles was filled on an interim, fixed term or locum basis reducing the stability of the trust.
The trust application of the equality and inclusion strategy across the range of staff and patient protected characteristics was better in some departments than others.
The referral to treatment times waiting lists, both pre- and post-pandemic, remained a challenge for the trust.
The fit and proper person checks for directors were not always completed in a timely way.
There needed continued investment in the estate to ensure appropriate care and support was provided to all patient groups.
How we carried out the inspection
During the core service inspection, we visited the location and sites for the 11 core services inspected, and we spoke to a range of staff, patients and key stakeholders. We also inspected the well-led key question for the trust overall. We conducted well-led interviews remotely.
You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.